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A New Approach to Fighting HIV/AIDS in Swaziland

In Swaziland, 26 percent of the population aged between 15 and 49 is HIV-positive. In 2007, Swaziland approached Doctors Without Borders/Médecins Sans Frontières (MSF) to ask for help in the fight against HIV and Tuberculosis and MSF started a project with the Ministry of Health (MoH). In February 2013, MSF started rolling out an innovative approach called PMTCT B+ for HIV-positive pregnant and breastfeeding women.

Gift Mumanga, Senior Nurse at Tfokotani Clinic, talks to a patient. “It’s not easy to have people tested," she says. "When the result is positive, they think ‘Oh, now people will push me aside.’ Taking a treatment for the rest of their lives is another fear for the patients.”

Johannes Zwane, community leader, says, “We are really encouraging men, especially young ones, to support their HIV-positive partners. Also I encourage them to come forward to get tested. I believe that once they have all the knowledge about HIV/AIDS, it is going to be easier for them to support their partners.”

Ephriem Dube, a traditional healer, is HIV-positive and on treatment. He says, “I treat all illnesses except for HIV. It is true that I still meet people who have misconceptions about HIV/AIDS, mostly because they are in denial. Even if you try to convince them, they still believe in the traditional medicines. It can be quite a challenge but I make an example of myself, I am a living testimony, I live with HIV.”

Magiyagiya Zwane, an MSF community expert patient, explains his experience. “It’s very simple for me to encourage a person [to get] testing for HIV. I always tell the people to look at me; I’m healthy, I’m living okay, so it is very easy to convince them. Once a person has tested, I always refer them to the clinic for their next steps."

Nomcebo Dlamini, an MSF clinic expert patient at Tfokotani Clinic, gives a health education talk to the patients. “We talk to patients so they can understand why testing is important. We also tell the patient how we ourselves have benefitted from taking antiretroviral treatment and how can it help them.”

An MSF community testing counselor explains HIV, how it is transmitted, and how it is prevented. Patient Support, Education, and Counseling teams and psychosocial assistants often visit the communities, especially in meeting areas such as farms and churches.

A pregnant HIV-positive patient says, “Now that I am on treatment, I can see a brighter future for me and my family because I will give birth to [an] HIV-free baby and I will take my older child and my husband for testing. I realize that the treatment I have started is a very important step in my life.”

A breastfeeding HIV-positive patient at home with her second and third children, who do not have the virus. She talks about the support from her husband who is also HIV-positive and on treatment. “I always encourage people to take action in the sense that taking antiretroviral treatment is not the end of life, you can still live a happy life.”

MSF works in close partnership with the MoH to show that this new approach is effective, accepted by pregnant women and health workers, and that it can be rolled out nationwide. This sign explains the collaboration between MSF and the MoH.

Hon. Benedict N. Xaba, minister of health, explains that the main challenges are how Swazi people will respond to this initiative and the costs associated with the approach. “We hope this initiative will not only help Swaziland but also become a successful example for other countries.” Elias Pavlopoulos, MSF head of mission, says, “We are here to be a catalyst for change, so that when we are out, essential antiretroviral treatment will be continued.”

“We talk to everyone because you are either infected or affected," says Dolly Zikalaka, MSF psychocial assistant. "Everyone must stand up and support each other.” Over the next four years, more than 2,000 pregnant and breastfeeding women are expected to start life-long antiretroviral treatment in Nhlangano. PMTCT B+ is the first step toward an HIV-free Swaziland.

September 18, 2013

MSF is working with the Swazi Ministry of Health on a new project called PMTCT B+ for HIV-positive pregnant and breastfeeding women.